Technology review: the use of simulators for training in GI endoscopy

Considerable advances have been made in the field of endoscopic simulation since the development of the first endoscopic mannequin simulator in the late 1960s.(1) Computer-based simulators have been developed for training in EGD, flexible sigmoldoscopy, colonoscopy, ERCP, and EUS. The purpose of this technical review is to present the current status of endoscopic simulation and to examine its role for training and assessing operator competence in both academic and community gastroenterology practices. The use of simulators for endoscopic training has several potentially attractive features. Physicians practicing in academic institutions face increasing demands to perform more patient care. Finding the time to train medical residents and gastroenterology fellows in endoscopic procedures has become a challenge. The use of endoscopic simulators, particularly early in the learning curve, is proposed as an alternative method for educating trainees about the technical aspects of endoscopic procedures. Patients have indicated dissatisfaction with procedures performed by trainees, particularly early in the training period. In addition, an increased frequency of minor adverse events associated with such procedures has been described.(2) The impact of endoscopic training on procedural time and financial revenues was previously studied by using 1997 to 1999 data from the Clinical Outcomes Research Initiative project, a large national endoscopy database.(3) Fellow involvement prolonged procedure time by 10% to 37%, with an estimated loss of reimbursement to the academic institution of $500,000 to $1,000,000 per year. The implementation of endoscopic simulators in the training process could partially reduce the adverse financial impact associated with training and theoretically could decrease adverse events and discomfort for patients.